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Oropharyngeal Deglutition in Stable COPD^*

^* From the Division of Pulmonary and Critical Care (Drs. Mokhlesi and Corbridge), Speech Pathology (Dr. Logemann and Ms. Stangl), and Preventive Medicine (Dr. Rademaker) of the Northwestern University Medical School and the Veterans Administration Chicago Healthcare System-Lakeside Division.

Correspondence to: Babak Mokhlesi, MD, Division of Pulmonary and Critical Care Medicine, Cook County Hospital/Rush Medical College, 1900 West Polk St, Room 914, Chicago, IL 60612; e-mail: Babak_Mokhlesi{at}rush.edu

Study objectives: The aim of this study was to examine deglutition in stable patients with COPD and lung hyperinflation.

Design: Twenty consecutive, eligible COPD patients with an FEV₁ 65% of predicted and a total lung capacity 120% of predicted were enrolled prospectively.

Intervention: Patients received a detailed videofluoroscopic evaluation of oropharyngeal swallowing and were compared to 20 age-matched and sex-matched historical control subjects.

Setting: An outpatient pulmonary clinic at a Veterans Affairs Medical Center.

Measurements and results: The mean total lung capacity, functional residual capacity, and residual volume for the patients were 128% of predicted, 168% of predicted, and 218% of predicted, respectively. The mean FEV₁ was 39% of predicted. There was no evidence of tracheal aspiration in either group. The laryngeal position at rest measured relative to the cervical vertebrae was not different between groups. The maximal laryngeal elevation during swallowing was significantly lower in patients with COPD (p < 0.001). Patients with COPD exhibited more frequent use of spontaneous protective swallowing maneuvers such as longer duration of airway closure and earlier laryngeal closure relative to the cricopharyngeal opening than did control subjects (p < 0.05).

Conclusions: We conclude that hyperinflated patients with COPD have an altered swallowing physiology. We suspect that the protective alterations in swallowing physiology (swallow maneuvers) may reduce the risk of aspiration. However, these swallowing maneuvers may not be useful during an exacerbation and may require further research.

Key Words: aspiration • COPD • oropharyngeal swallow • swallow maneuvers • videofluoroscopy

This article has been cited by other articles:

				S. Teramoto, H. Kume, Y. Ouchi, and B. Mokhlesi Altered Swallowing Physiology and Aspiration in COPD Chest, September 1, 2002; 122(3): 1104 - 1105. [Full Text] [PDF]